Contraception – what options are there?

What methods of contraception are available?

There are numerous methods of contraception, but there is no single ideal method that meets everyone’s needs at every stage of life. Choosing the right method of contraception always depends on individual needs, lifestyle and health factors.

The most common methods of contraception include hormonal options such as the pill, the contraceptive patch or the vaginal ring. There are also non-hormonal methods such as condoms, intrauterine devices (IUDs), diaphragms and various natural methods of contraception. A key criterion for assessing the safety of a contraceptive is the Pearl Index.

It is important to find out about the various options and, if necessary, to speak to a doctor to find the most suitable method.

What is the Pearl Index?

The Pearl Index (named after the US scientist Raymond Pearl) is a measure used to assess the effectiveness of contraceptive methods. It indicates how many out of 100 women become unintentionally pregnant when using a particular contraceptive method for one year. The lower the Pearl Index, the more reliable the method. This means that fewer than one in 100 women who take the pill for a year will become pregnant. (By comparison, the Pearl Index for women who do not use contraception is 85, based on those who have sexual intercourse without protection for a year.)

However, it is important to note that the Pearl Index is merely a guideline. The actual effectiveness of contraceptives also depends on their correct use, and the Pearl Index takes into account possible user errors. Therefore, some contraceptive methods may be more effective than their Pearl Index suggests when used correctly.

A comparison of the different contraceptive methods:

Hormonal contraceptive methods

This category includes various contraceptives that are used in different ways but work in a similar way. What they have in common is that they affect hormone levels and are considered very safe when used correctly.

The pill

These are usually combined preparations containing both oestrogens and progestogens. These hormones suppress ovulation, alter cervical mucus and prevent the monthly build-up of the endometrium.

The pill has a Pearl Index of 0.2 to 0.5 and is considered a very safe contraceptive provided it is used correctly. However, unwanted side effects such as nausea, weight gain or breakthrough bleeding may occur. Furthermore, the pill cannot be used whilst breastfeeding and is not suitable for certain high-risk groups.

Three-month injection

The injection is administered every three months by a gynaecologist and contains a high dose of a long-acting progestogen. This prevents ovulation and alters the lining of the womb so that sperm cannot enter it.

The three-month injection has a Pearl Index of 0.2 to 4 and is a safe method of contraception. However, it is not recommended for women with risk factors for osteoporosis and may cause side effects such as breakthrough bleeding and spotting. After stopping treatment, it takes some time for the cycle to return to normal and for fertility to be restored.

Hormonal IUD

This is a T-shaped plastic tube that must be inserted by a gynaecologist and is fitted with a hormone-releasing cylinder. The cylinder continuously releases small amounts of progestogen, which thickens the cervical mucus and suppresses the growth of the endometrium.

The hormonal IUD has a Pearl Index of 0.1 to 0.2 and is considered a very safe method of contraception, offering protection against unwanted pregnancy for three to five years. The hormonal coil must be fitted by a doctor, which some women may find uncomfortable or painful. Some women experience side effects such as breakthrough bleeding, spotting, headaches, breast tenderness or mood swings.

Hormone implant

This is a soft plastic rod which is inserted under the skin on the inside of the upper arm by a gynaecologist. It releases small amounts of progestogen into the body, preventing ovulation and altering the cervical mucus so that sperm cannot enter the womb.

The hormonal implant has a Pearl Index of 0.1 and provides three years’ protection against unwanted pregnancy. Possible side effects include headaches, weight gain and breakthrough bleeding.

Vaginal ring

A flexible plastic ring that women insert into their vagina themselves. It remains in place for three weeks and is then removed for one week to allow for a monthly period. After that, a new vaginal ring can be inserted.

The vaginal ring releases oestrogen and progestogen steadily and works in a similar way to the combined pill. It has a Pearl Index of 0.3 to 7 and is considered safe, but may cause side effects such as headaches, vaginal infections, acne, nausea or heavier periods.

Contraceptive patch

This is a thin, self-adhesive patch which is applied directly to the skin on the first day of your period and worn for seven days; it is then replaced with a new patch after a one-week break. The patch contains oestrogen and progestogen, which are absorbed through the skin, and works in a similar way to the combined oral contraceptive pill.

The contraceptive patch has a Pearl Index of 0.3 to 7 and is considered a safe method. However, it can lead to irregular bleeding and other side effects and is not suitable for certain risk groups.

What is Natural Family Planning (NFP)?

Natural Family Planning (NFP) is a method of contraception based on observing and recording the natural physical changes in a woman’s menstrual cycle. It involves observing various bodily signs and recording these observations. NFP can be used to identify fertile and infertile days.

These methods can be used both to prevent pregnancy and for targeted family planning for couples wishing to have children. Natural Family Planning offers a hormone-free alternative to other contraceptive methods.

How do chemical contraceptives work?

Chemical contraceptives are available in the form of suppositories, creams, tablets, gels or foams. They alter the vaginal environment, thereby paralysing or killing the sperm. Chemical contraceptives must be inserted into the vagina before sexual intercourse; you must then wait for about ten minutes for them to take effect.

However, it is important to note that, compared to other contraceptive methods, chemical contraceptives are considered less reliable. The Pearl Index ranges from 16 to 21 and is regarded as an unreliable method.

What are mechanical contraceptives?

Mechanical contraceptives, which include condoms, female condoms (femidoms) and diaphragms, are designed to prevent sperm from entering the vagina and thus prevent the fertilisation of an egg.

Condom

Condoms are made of ultra-thin rubber or latex and are pulled over the erect penis to prevent sperm from entering the vagina. Condoms have a Pearl Index of 2 to 13 and are considered less reliable as they can burst or tear. Errors in use, such as putting the condom on incorrectly, using it in conjunction with creams or oils, or using it past its use-by date, can compromise its effectiveness.

Condoms do, however, offer effective protection against HIV and other sexually transmitted infections (STIs). It is important to note, however, that the material can also trigger allergic reactions.

Female condom (Femidom)

The Femidom is a thin plastic sheath with a flexible ring at each end. The smaller ring is inserted into the vagina and covers the cervix. The larger ring remains outside the vaginal opening. The Femidom prevents sperm from entering the uterus via the cervix.

The female condom has a Pearl Index of 5 to 21 and is considered less reliable. An important advantage is that the Femidom protects against STIs and does not require any surgical intervention. However, it takes some practice to use and is only available online.

Diaphragm

The diaphragm is a flexible cap made of latex or silicone that forms a barrier to the uterus, thereby preventing the egg and sperm from meeting. It is inserted into the vagina before sexual intercourse and must be used with a spermicidal cream. If looked after properly, the diaphragm has a lifespan of around two years.

The diaphragm has a Pearl Index of 16 and is considered less reliable. It has the advantage of not interfering with hormone levels. However, it requires practice to insert and must remain in the vagina for at least eight and up to 24 hours after sexual intercourse.

Intrauterine device (IUD)

The coil is considered a reliable method of contraception. It is available as a copper coil, copper chain, copper ball or hormonal coil (see above).

Copper IUD

The copper IUD is a soft, usually T-shaped plastic rod wrapped in a fine copper wire. The copper IUD must be fitted by a gynaecologist and, depending on the model, can remain in the womb for between three and ten years. The copper, which is continuously released in small quantities, inhibits the motility and fertilising capacity of the sperm, whilst the position of the IUD prevents the fertilised egg from implanting should fertilisation occur. Alternatively, there are also the copper chain and the copper ball, which work on the same principle.

The copper IUD has a Pearl Index of 0.6 to 0.8 and is considered a very reliable method of contraception. It does not affect hormone levels and can also be used whilst breastfeeding. However, the IUD may lead to prolonged bleeding and increased period pain.

What surgical options are available?

Female sterilisation (tubal ligation)

This surgical procedure results in permanent infertility by blocking the fallopian tubes, preventing the egg and sperm from meeting. This is achieved by removing a section of the fallopian tubes and then tying, clamping or cauterising the ends of the tubes. The operation is usually carried out on an outpatient basis under general anaesthesia.

Female sterilisation has a Pearl Index of 0.2 to 0.5 and is considered a very safe method of contraception, but is only suitable for women who have completed their family planning.

Male sterilisation (vasectomy)

A vasectomy is a surgical procedure that results in permanent infertility. In this procedure, the vas deferens are severed at two points and the section between them is removed. The exposed ends are folded back and sealed with a suture or cauterised using an electric current. The procedure is simpler to perform than the female equivalent and is usually carried out on an outpatient basis under local anaesthesia. A vasectomy has a Pearl Index of 0.1 to 0.15 and is considered a very safe method for those who have finished planning their family.

Advice and support on contraception

There are now a wide variety of contraceptive methods available, and choosing the one that is right for you requires good advice. This can be obtained from a gynaecologist you trust. There are also advice centres where you can obtain information and support. For example, you can contact the following organisations:

Austrian Society for Family Planning

https://oegf.at/familienplanung/beratungsstellen

Women’s Health Centres

https://fem.at

First Love Counselling Centre

https://firstlove.at/verhutung

You can find leaflets on contraception, for example, at:

https://oegf.at/produkt/wir-haben-lust-darauf-verhuetung-im-ueberblick/

https://shop.bzga.de/sichergehn-verhuetung-fuer-sie-und-ihn-c-293/